The Nation

Repeat duty tied to acute stress

A survey by the Army indicates the mental health of soldiers on return deployment to Iraq has suffered.

WASHINGTON — American soldiers who serve repeated tours of duty in Iraq are more likely to suffer from acute stress, according to a mental health survey released Tuesday by the Army.

Overall, 13.6% of soldiers serving in Iraq reported suffering from acute stress in late 2005, when the survey was taken. Among soldiers serving their first tours, 12.5% reported suffering such stress. But among soldiers on their second tour of duty, the figure jumped to 18.4%.

"There is a sense that the yearlong deployments are challenging, even if morale is good," said Lt. Gen. Kevin Kiley, the Army's surgeon general. "The normal things -- births, first steps, birthdays -- those are missed. When soldiers are on second or third tours, my sense is they feel that a bit more."

The adverse effect of multiple, long deployments is a critical factor for military leaders as they consider increasing the number of troops in Iraq. If the White House orders a surge in the force size in an effort to control sectarian violence, the military will probably have to extend the tours of thousands of combat soldiers, keeping them in Iraq longer than a year.

In addition, the number of soldiers on their third tour is likely to increase next year, with the return of the Army's 3rd Infantry Division.

Paul Rieckhoff, the founder of Iraq and Afghanistan Veterans of America, an advocacy group, said he expected to see the numbers of soldiers reporting acute stress increasing, especially if troop levels rose.

"It is a bad sign of things to come," Rieckhoff said of the report. "There is a tremendous mental health toll to this war. That toll is only going to continue as we repeatedly ask the same people to sacrifice again and again. It is not just the equipment being run down, it is the people."

Col. Edward O. Crandell, who helped oversee the survey, said it was too early to know for sure why soldiers on second tours had higher stress levels. But he said the increased stress may be helpful -- a way to stay sharp in a dangerous situation.

"In some ways, in the soldier's mind it may be adaptive to maintain that heightened level of arousal," Crandell said. "I have had numerous soldiers tell me: 'I am going back. I need to be pumped. I need to be ready to do this.' "

The survey did not examine the effect of extensions on mental health. But soldiers have reported in focus groups that stress rises near the end of their tours and that the long deployments are difficult, the Army researchers said.

"You are going to have all kinds of problems, discipline problems, all kinds of mistakes, misconduct," said Stephen N. Xenakis, a psychiatrist and retired brigadier general in the Army medical corps. "Everyone feels things will go downhill by extending tours."

The survey, known as the Mental Health Advisory Team Report, is the third the Army has released since the beginning of the war. The results are based on a poll of soldiers taken in October and November 2005. Kiley said it took a more than a year to analyze the data and then brief officials in Iraq and at the Pentagon on the results.

The results were not held back until after the midterm election, he said. "There was nothing nefarious in the delay," Kiley said.

Army officials have finished collecting 2006 survey data, but there are no preliminary results yet, Kiley said.

The mental health report also found fluctuations in the rate of suicides among soldiers in Iraq. The 2005 rate was 19.9 per 100,000, up from 10.5 the year before. In 2003, the rate was 18.8 per 100,000. The data are based on the actual number of suicides among soldiers in Iraq: 22 in 2005, 11 in 2004 and 25 in 2003.

"We consider one suicide to be too many," Kiley said.

He added that the suicide rate in the Army has fluctuated over time, and he cautioned against reading anything into the latest numbers, saying the change was not statistically significant. The rates are slightly lower than those for the general population of young men, he said.

Army researchers have not been able to make a connection between the stress on the force and the suicide rate. The Army is trying to develop better ways to identify people at risk for suicide. But most suicides occurred on impulse and could have been related to relationship problems or financial stress, as opposed to combat stress, Kiley said.

But Rieckhoff thinks the official numbers underestimate the severity of the problem because they do not account for suicides that occur after a soldier has left the Army.

Kiley said the Army was concerned that soldiers on their second or third tours in Iraq might be at a increased risk of post-traumatic stress disorder upon their return. But he said they had not found any link between multiple tours and suicide rates.

The report can be viewed online at www.armymedicine.army.mil/news/news.html.